Previous changes

May 2021 — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• No changes to clinical recommendations have been made, but the topic structure has been changed. 
• The Quality and Outcomes Framework (QOF) indicators listed below have been removed as they were retired in April 2019 [BMS and NHS England, 2019]:
  • CON001: The contractor establishes and maintains a register of women aged 54 or under who have been prescribed any method of contraception at least once in the last year, or other clinically appropriate interval, for example, the last 5 years for an IUS.
  • CON003: The percentage of women, on the register, prescribed emergency hormonal contraception one or more times in the preceding 12 months by the contractor who have received information from the contractor about long-acting reversible contraception at the time or within one month of the prescription.

March to April 2016 — reviewed. A literature search was conducted in March 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. Minor structural changes have been made.

June 2013 — minor update. The 2013 Quality and Outcomes Framework (QOF) options for local implementation have been added to this topic.

March 2013 – minor update. The telephone number for NHS Direct has been updated.

February to June 2012 — reviewed. A literature search was conducted in December 2011 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No changes to clinical recommendations have been made. However, recommendations have been rewritten for clarity, and superseded guidelines and manufacturers' Summary of Product Characteristics have been updated accordingly.

March 2011 — the topic structure has been revised to ensure consistency across CKS topics. No changes to clinical recommendations have been made. Issued in June 2011.

December 2010 — minor update. Type B diaphragms BS 4028 Type 1 (coil spring) are no longer listed in the Drug Tariff. Prescriptions have been removed. Note that the Milex omniflex® coil spring diaphragms are still available to prescribe. Issued in January 2010.

February 2010 — updated to include the revised UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) published by the College of Sexual and Reproductive Healthcare (CoSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC). Issued in January 2010.

March 2009 — minor update. The QOF indicators for sexual health have been updated in the section on Goals and outcome measures. Issued in April 2009.

December 2008 — minor update. All-flex® latex diaphragms (all sizes) have been discontinued. The text has been updated and prescriptions removed. Issued in January 2009.

March 2008 — minor update. Ortho-creme® has been discontinued. Prescriptions for Ortho-creme® have been removed and replaced with Gygel®. Issued March 2008.

April to September 2007 — converted from CKS guidance to CKS topic structure. The evidence base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

July 2006 — minor update. Information regarding orlistat and reduced efficacy of oral contraceptives has been included in the section on Drug interactions. Issued in July 2006.

January 2006 — minor update. Gynol II Jelly, Microval tablets, and Duragel have been discontinued, and the prescriptions have been removed. The Black triangle status has been removed from Cerazette®. Issued in February 2006.

October 2005 — updated to include the new recommendations on missed pills from the FFPRHC, published in April 2005. Issued in November 2005.

April 2005 — minor update. Neogest® tablets have been discontinued, and the prescriptions have been removed. Issued in April 2005.

February 2005 — updated to include prescribing advice from the Committee on Safety of Medicines (CSM) on the effect of depot medroxyprogesterone acetate (DMPA) contraception on bones. Issued in February 2005.

September 2004 — updated to include the World Health Organization (WHO) Medical Eligibility Criteria relating to contraception for 2004 and recent licence changes to Cerazette®. Delfen® Contraceptive Foam is being discontinued at the end of October 2004, and the prescriptions have been removed. Issued in September 2004.

January 2004 — reviewed. Validated in March 2004 and issued in June 2004.

January 2001 — rewritten. Validated in March 2001 and issued in June 2001. Guidance on emergency contraception is no longer included in the Contraception guidance but can be found as a separate CKS topic.

December 1997 — written.

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 July 2026.

HTAs (Health Technology Assessments)

No new HTAs since 1 July 2026.

Economic appraisals

No new economic appraisals relevant to England since 1 July 2026.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 July 2026.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 July 2026.

New policies

No new national policies or guidelines since 1 July 2026.

New safety alerts

No new safety alerts since 1 July 2026.

Changes in product availability

No new changes in product availability since 1 July 2026.

What are the advantages and disadvantages of male condoms?

• Advantages 
  
  • They are easy to obtain and use.
  • They only need to be used during sexual activity.
  • They provide protection against sexually transmitted infections (STIs), including HIV.
  • When used consistently and correctly, male latex condoms can increase the rate of human papillomavirus clearance and regression of cervical intraepithelial neoplasia.
  • They are not compromised by concurrent drug treatment (for example, liver enzyme-inducing drugs).
  • Adverse effects are rare.
  • They are potentially suitable for use by most people as they are a non-hormonal form of contraception.
• Disadvantages 
  • Forward planning is required, and sex may be interrupted. 
  • The participation and commitment of both partners are required, as well as motivation at each act of intercourse.
  • They are less effective at preventing pregnancy than hormonal and intrauterine contraception.
  • They can break or slip off during intercourse.
  • Loss of sensitivity during intercourse may occur.
  • Men who sometimes lose their erections during sex may find it difficult to use a male condom correctly.
  • Used condoms need careful disposal.  
  • Allergy to latex can rarely occur.

[CoSRH, 2015; Kopa, 2024; WHO, 2025]

What are the advantages and disadvantages of female condoms?

• Advantages 
  • They are easy to use.
  • They only need to be used during sexual activity.
  • They provide protection against sexually transmitted infections (STIs), including HIV.
  • They can be used with oil-based lubricants because they are made of polyurethane.
  • They can be used if either partner is allergic to latex.
  • They can be inserted at a convenient time (up to 8 hours) before intercourse, so that spontaneity can be maintained.
  • They are less likely to tear than the latex male condom.
  • They are not compromised by concurrent drug treatment (for example liver enzyme-inducing drugs).
  • There are no known adverse effects.
  • They are potentially suitable for use by most women as they are a non-hormonal form of contraception.
• Disadvantages 
  • They require careful insertion.
  • They require planned use for each act of intercourse.
  • During intercourse, they can slip out, get pushed into the vagina, be dislodged, or the penis can be inserted between the vaginal wall and the condom.
  • They can be noisy during intercourse.
  • The inner ring may cause discomfort during sex.
  • They are less effective at preventing pregnancy than hormonal and intrauterine contraception.
  • Used condoms need careful disposal.  

[CoSRH, 2015; WHO, 2022; WHO, 2025]

What are the advantages and disadvantages of using diaphragms or cervical caps?

• Advantages 
  • They can be inserted at a convenient time (up to 3 hours) before intercourse so that spontaneity can be maintained.
  • The woman can control the use of contraception.
  • They are not compromised by concurrent drug treatments (for example, liver enzyme-inducing drugs).
  • Adverse effects are rare.
  • They are potentially suitable for use by most women as they are a non-hormonal form of contraception.
• Disadvantages of diaphragms and cervical caps
  • They are less effective at preventing pregnancy than hormonal and intrauterine contraception.
  • Failure rates for cervical caps (but not diaphragms) may be increased for parous women.
  • They require motivation and careful use on each occasion to be effective.
  • They require planning so that the diaphragm or cap is in place or readily available.
  • The diaphragm or cap must be left in place for at least 6 hours after sexual intercourse.
  • They cannot be used until 6 weeks post-partum or 6 weeks following second trimester termination.
  • The fit needs to be rechecked after weight gain or loss of 3 kg or more, and after giving birth.
  • Some women may be allergic to the material from which the diaphragm is made.
  • They must be used with spermicide, which may cause irritation or allergy.
  • The incidence of urinary tract infection may be increased in some women who use diaphragms — this often relates to the fit and size of the diaphragm, which may put pressure on the urethra.
  • They may not reduce the risk of transmission of sexually transmitted infections (STIs).
  • They should not be used by women at high risk of STIs, as spermicides can increase the risk of infection.
  • They should not be used while menstruating due to an increased risk of toxic shock syndrome.
  • Some women find them messy to use.

[CoSRH, 2015; WHO, 2022; WHO, 2025; Brook, 2026]

How should I assess a person considering a barrier method of contraception?

• If a person is considering a barrier method of contraception, an assessment should be done to confirm the suitability of the method. As part of the assessment, the World Health Organization Medical Eligibility Criteria for Contraceptive Use should be applied to assess the eligibility for use of the method.
• See the CKS topic on Contraception - assessment for information on how to assess a person considering a barrier method of contraception.

What information and advice should I give to a person requesting male condoms?

• Provide verbal and written information on male condoms.
  • This should include information on:
    • How male condoms work.
    • How effective they are at preventing pregnancy, including the failure rate relative to other methods of contraception, such as long-acting reversible contraception (LARC).
    • How effective they are at preventing sexually transmitted infections (STIs).
    • The advantages and disadvantages of the male condom.
    • Where to obtain male condoms.
    • How to use male condoms correctly, including information on when emergency contraception and/or testing for STIs may be required.
  • Information on male condoms is available from several sources, including:
    • The NHS website (www.nhs.uk).
    • Brook (www.brook.org.uk).

How should a male condom be used?

• Advise the person that: 
  • Before using the condom, they should check that the packaging has the relevant safety markings (for example, BSI and CE Kitemarks) and that the condom is within the use-by date.
  • A new condom should be used for each episode of sexual intercourse or if applied incorrectly.
  • No more than one condom should be worn simultaneously by one person.
  • Male and female condoms should not be used simultaneously for the same act of intercourse.
  • Care should be taken when handling condoms as sharp objects, such as fingernails, teeth, or jewellery, can tear them.
  • The use of condoms lubricated with spermicide is not recommended. See the section on Spermicide for more information.
  • They should not:
    • Use oil-based products (such as baby oil and petroleum jelly) with latex condoms or with condom brands made from polyisoprene (Skyn^®) or lamb intestine (Naturalamb^®), as they can damage the latex and make the condom more likely to split. Non-latex male condoms made from polyurethane are unaffected by oil-based lubricants.
    • Apply a lubricant to the penis under a male condom, as this can result in the condom slipping off.
  • Vaginal and topical preparations containing econazole, miconazole, isoconazole, fenticonazole, or clotrimazole may damage latex condoms.
• Provide information on the correct use of the male condom. 
  
  • Advise that:
    • The condom should not be unrolled until it is placed on an erect penis.
    • The condom should be rolled down to the base of the penis before there is genital contact.
    • If the condom does not reach the base of the penis, then it is likely that the condom is inside out. It should be removed and replaced with a fresh one.
    • After ejaculation, the man should withdraw before the penis goes soft.
    • Removal of the condom from the penis should occur away from the vagina, anus, or genital area.
    • Used condoms should be disposed of by wrapping in tissue and placing in the bin (not flushed down the toilet).
  • Information on male condoms is available from several sources, including:
    • The NHS website (www.nhs.uk).
    • Brook (www.brook.org.uk)
• Advise the person that there may be a risk of pregnancy or sexually transmitted infections (STIs) if the condom breaks, splits, slips, or leaks.
  • They should seek advice from a GP, pharmacist, or sexual health clinic because emergency contraception (EC) and/or STI testing may be indicated.
  • EC may also be indicated in the following situations (this is not an exhaustive list):
    • Failure to use condoms as advised when starting or switching contraception.
    • If enzyme-inducing drugs are being used alongside hormonal contraception and condoms are not used during or for 28 days after.
  • See the CKS topic on Contraception - emergency for more information on when EC is indicated.

How should I manage suspected allergy or sensitivity to male latex condoms?

• If either partner develops genital irritation due to suspected latex allergy/sensitivity:
  
  • Check the type of condom being used and whether it is pre-lubricated with a spermicide.
    • Reactions to spermicides are more common than reactions to latex.
    • The use of condoms lubricated with spermicide is not recommended.
  • Exclude alternative diagnoses, such as atopic eczema, contact dermatitis, or vulvovaginal candidiasis. For more information, see the CKS topics on Eczema - atopic, Dermatitis - contact, and Candida - female genital.
  • Advise the person to use non-latex condoms. Deproteinized male latex condoms may also be considered.
• If the symptoms do not resolve after these measures, consider further investigations.

How should I assess a person considering a barrier method of contraception?

• If a person is considering a barrier method of contraception, an assessment should be done to confirm the suitability of the method. As part of the assessment, the World Health Organization Medical Eligibility Criteria for Contraceptive Use should be applied to assess the eligibility for use of the method.
• See the CKS topic on Contraception - assessment for information on how to assess a person considering a barrier method of contraception.

What information and advice should I give to a woman requesting female condoms?

• Provide verbal and written information on female condoms.
  • This should include information on:
    • How female condoms work.
    • How effective they are at preventing pregnancy, including the failure rate relative to other methods of contraception, such as long-acting reversible contraception (LARC).
    • How effective they are at preventing sexually transmitted infections (STIs).
    • The advantages and disadvantages of the female condom.
    • Where to obtain female condoms.
    • How to use female condoms correctly, including information on when emergency contraception and/or testing for STIs may be required.
  • Information on female condoms is available from several sources, including:
    • The NHS website (www.nhs.uk).
    • Brook (www.brook.org.uk).

How should a female condom be used?

• Advise the woman that: 
  • Before using the condom, she should check that the packaging of the condom has the relevant safety markings (for example, BSI and CE Kitemarks) and is within the use-by date.
  • A new condom should be used for each episode of sexual intercourse or if applied incorrectly.
  • No more than one condom should be worn simultaneously by one person.
  • Female and male condoms should not be used simultaneously for the same act of intercourse.
  • Care should be taken when handling condoms as sharp objects, such as fingernails, teeth, or jewellery, can tear them.
  • The use of condoms lubricated with spermicide is not recommended. See the section on Spermicide for more information.
• Provide information on the correct use of the female condom. 
  
  • Advise that:
    • The condom should be inserted before the penis comes into contact with the genital area.
    • The penis should be guided into the condom so that it does not enter between the vagina and the condom.
    • It is normal for the condom to move during intercourse, but it will remain effective if the penis stays inside it.
    • After intercourse, the condom should be removed immediately by twisting the outer ring of the condom to keep the semen inside, then pulling the condom gently out of the vagina. 
    • Used condoms should be disposed of by wrapping in tissue and placing in the bin (not flushed down the toilet).
  • Information on female condoms is available from several sources, including:
    • The NHS website (www.nhs.uk).
    • Brook (www.brook.org.uk)
• Advise the woman that there may be a risk of pregnancy or sexually transmitted infections (STIs) if the condom breaks, splits, slips, or leaks.
  • She should seek advice from a GP, pharmacist, or sexual health clinic because emergency contraception (EC) and/or STI testing may be indicated.
  • EC may also be indicated in the following situations (this is not an exhaustive list):
    • Failure to use condoms as advised when starting or switching contraception.
    • If enzyme-inducing drugs are being used alongside hormonal contraception and condoms are not used during or for 28 days after.
  • See the CKS topic on Contraception - emergency for more information on when EC is indicated.

How should I assess a person considering a barrier method of contraception?

• If a person is considering a barrier method of contraception, an assessment should be done to confirm the suitability of the method. As part of the assessment, the World Health Organization Medical Eligibility Criteria for Contraceptive Use should be applied to assess the eligibility for use of the method.
• See the CKS topic on Contraception - assessment for information on how to assess a person considering a barrier method of contraception.

What information and advice should I give to a woman requesting a diaphragm or cervical cap?

• Provide verbal and written information on diaphragms and caps.
  • This should include information on:
    • How diaphragms and caps work.
    • How effective they are at preventing pregnancy, including the failure rate relative to other methods of contraception, such as long-acting reversible contraception (LARC).
    • The advantages and disadvantages of diaphragms or caps.
    • Where to obtain diaphragms or caps.
    • How to use diaphragms or caps correctly, including information on when emergency contraception may be required.
  • Information on diaphragms and cervical caps is available from several sources, including:
    • The NHS website (www.nhs.uk).
    • Brook (www.brook.org.uk)
• Provide information on how to reduce the risk of sexually transmitted infections (STIs).
  • Advise that:
    • Diaphragms or caps may not reduce the risk of transmission of STIs.
    • When used correctly and consistently, male condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe but are not used as widely as male condoms.

How should diaphragms or cervical caps be used?

• Advise the woman that:
  • Diaphragms and caps should initially be fitted by a trained and competent healthcare professional. She should use the diaphragm or cap with another method of contraception (such as condoms) until she has been reassessed to review the fit of the device and her skills in using it.
  • Before inserting the diaphragm or cervical cap, she should check for any holes or deterioration. The diaphragm or cap should be replaced immediately if there are any holes or puckering. Discolouration with use is normal; the latex is unaffected.
  • Diaphragms and caps must be used in conjunction with a spermicide.
  • Oil-based products (such as baby oil, some topical corticosteroids, and oestrogen preparations) are likely to damage latex diaphragms and caps and may render them less effective as a barrier method of contraception.
  • An alternative contraception method should be used during her period.
  • The fit of the diaphragm or cap should be rechecked by a trained healthcare professional:
    • After childbirth, termination of pregnancy, or miscarriage. Women are advised to wait 6 weeks after delivery before using the diaphragm or cervical cap, to allow the uterus to return to its pre-pregnancy size and condition.
    • If she experiences significant weight gain or loss (3 kg or more) as the vagina and cervix can change shape or size.
• Provide information on the correct use of a diaphragm or cap.
  • Advise that:
    
    • When using a diaphragm, approximately two 2 cm strips of spermicide should be applied to the upper surface of the diaphragm. Some spermicide can be applied to the leading edge of the rim to ease insertion.
    • When using a cap, the inside of the cap should be filled about a third with spermicide. Spermicide should not be put on the rim of a cervical cap as it may stop it from staying in place.
    • The diaphragm or cervical cap should be inserted up to 3 hours before sexual intercourse and must be left in situ for at least 6 hours after the last episode of sexual intercourse — sperm in the lower reproductive tract are unlikely to survive after 6 hours. 
    • Diaphragms should be removed within 30 hours of insertion, and caps within 48 hours.
    • Additional spermicide should be applied before sex is repeated or if the diaphragm or cervical cap has been in situ for 3 hours or more before sex takes place. The diaphragm or cervical cap should not be removed to reapply spermicide. 
    • After intercourse, the diaphragm or cap should be washed with mild unscented soap, rinsed well, dried carefully, and stored in a cool place. 
  • Information on diaphragms and cervical caps is available from several sources, including:
    • The NHS website (www.nhs.uk).
    • Brook (www.brook.org.uk).
• Advise the woman that there may be a risk of pregnancy if the diaphragm or cap is damaged, dislodged, or used incorrectly (for example, wrongly inserted, removed within 6 hours of sexual intercourse, or is left in for longer than 3 hours before sex and no additional spermicide applied).
  • She should seek advice from a GP, pharmacist, or sexual health clinic because emergency contraception (EC) may be indicated. See the CKS topic on Contraception - emergency for more information on when EC is indicated.

How should I follow up a woman after a diaphragm or cervical cap has been fitted?

• Reassess the woman after 1–2 weeks to review the fit of the device and the woman's skills in using it.
  
  • Ask:
    • If she is comfortable while using the method for the duration of its use, including during intercourse.
    • If she is able to tolerate keeping it in overnight if sex occurs in the evening.
    • If there is an intolerance or adverse effect to the spermicide.
  • Ensure that the woman is able to check the position of the diaphragm or cervical cap before and after intercourse, and recognize if it is correctly positioned.
  • Remind the woman that:
    • When inserted correctly, neither partner should be able to feel the diaphragm or cap. If the diaphragm or cap can be felt or is uncomfortable, she should return to reassess fit or consider an alternative diaphragm or cap or another method of contraception.
    • The diaphragm or cap should be replaced immediately if there are any holes or puckering. Discolouration with use is normal; the latex is unaffected.
  • Advise the woman that the fit of the diaphragm or cap should be rechecked by a trained healthcare professional:
    • After childbirth, termination of pregnancy, or miscarriage. Women are advised to wait 6 weeks after delivery before using the diaphragm or cervical cap, to allow the uterus to return to its pre-pregnancy size and condition.
    • If she experiences significant weight gain or loss (3 kg or more) as the vagina and cervix can change shape or size.